Thinking skills and literacy in children with ADHD

We have recently published systematic reviews about thinking skills and their relationship to difficulties in maths and literacy in children with ADHD. Today we will summarise the findings of the review that focused on literacy. So first of all, what is a ‘systematic review’? A systematic review is a summary of all of the literature that has been published on a specific topic. The authors make decisions before hand about criteria that the research studies must meet such as for example that the review will include children in primary school only or who have a confirmed diagnosis. The authors then comprehensively search all of the available literature with those criteria and arrive at a final set of studies to be included. In our literacy review, we also did what is called a ‘meta-analysis’ – this involves doing a statistical analysis on the data produced by the studies in the review that combines them. Both a systematic review and a meta-analysis are therefore important ways of putting together and understanding a research area that draws on as much robust studies as possible. The conclusions made then reflect the studies across that field rather than a conclusion that comes from a single study result.

The review we are going to focus on today was on the topic of thinking skills and literacy. We chose to examine studies that focused on literacy broadly and not just reading as we know that young people with ADHD, their parents and teachers often make comments that difficulties lie beyond reading. This makes sense if you think about writing for example and the importance of planning in creating a story that has a beginning, middle and an end.

So what did our review and meta-analysis find? Using our criteria we ended up with a review that included 6 studies. The age of participants in the studies ranged from 6 to 16 years with an average age of 9. We found there was a fairly small set of studies conducted that met our criteria and had looked beyond reading to other aspects of literacy. Researchers mainly focused on ‘working memory’ (the mental workspace where you hold and organise information for a brief time), but some also looked at ‘inhibitory control’ (difficulty with avoiding distractors and generally controlling responses). Attention was also examined and several included measures of ‘processing speed’ (how long it takes to get something done). Surprisingly given our example above none of the studies had included a measurement of planning or broader organisation skills.

What did the review and analysis find then? We found a series of relationships between different aspects of literacy and thinking skills. Poorer working memory skills were linked to a wide range of aspects of literacy difficulties including word reading, reading comprehension (being able to understand what is being read), writing and spelling. What this means is that if a child has difficulties in working memory they are likely to need supports and strategies in place when doing tasks that involve literacy. Having difficulties in inhibitory control, which we know is a key characteristic of many children with ADHD, was related to poorer spelling. Attention was only examined in one study and was found to be associated with reading. Processing speed, or how long it takes to get something done, was not consistently linked to literacy, although may be relevant for writing. We concluded that much more research needs to be done on this important topic.

Understanding thinking difficulties and their relationship to literacy is really important in arriving at suitable supports and strategies for optimising literacy learning for children with ADHD. In our Strategy booklet we describe a range of techniques to encourage children to practice these thinking skills and strategies that can be used to help children engage optimally with their academic learning.

The full paper can be found here: https://bpspsychub.onlinelibrary.wiley.com/doi/epdf/10.1111/bjdp.12395

Visual production credit: photographer monkeybusiness images via Getty images.

Author: Sinead Rhodes

Senior Research Fellow, Centre for Clinical Brain Sciences, University of Edinburgh Founder and Chair of Research the Headlines RSE Young Academy of Scotland

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